Symptoms
The possible acute symptoms of type 2 diabetes include:
- Thirst (polydipsia) and hunger (polyphagia).
- Increased urination (polyuria).
- Visual disturbances
- Weight loss
- Fatigue, exhaustion, declining performance.
- Poor wound healing, infectious diseases.
- Skin lesions, itching
- Acute complications: Hyperacidity (ketoacidosis), hyperosmolar hyperglycemic syndrome.
Untreated diabetes is far from harmless and can lead in the longer term to serious late effects such as cardiovascular disease (heart attack, stroke), nerve damage, kidney disease, blindness and amputations.
Causes
The cause of the disease is an inadequate response of the body to the hormone insulin (insulin resistance) and the resulting increase in blood sugar (hyperglycemia). This hormone is produced in the pancreas by the beta cells and is mainly responsible for the uptake of glucose into the cells. In the longer term, reduced insulin secretion also contributes to the development of the disease. Diabetes mellitus type 2 is essentially a disease of civilization with a hereditary component, the development of which is predominantly favored by the following risk factors:
- Overweight, abdominal fat
- Sedentary lifestyle, little physical activity.
- Unhealthy diet
- Factors that cannot be influenced: Age, heredity, ethnicity
Diagnosis
Diagnosis is made in medical treatment based on patient history, physical examination and with measurements of blood parameters. For several years, the HbA1c value has been primarily recommended for diagnosis (glycosylated hemoglobin, ≥ 6.5%). Two other options are the determination of the blood glucose value (fasting ≥ 7 mmol/L) and an oral glucose tolerance test (oGTT, ≥ 11.1 mmol/L). In particular, HbA1c and also blood glucose are also measured for follow-up during treatment.
Nonpharmacologic treatment
The goal of treatment is to relieve acute symptoms and prevent late complications. Currently, manifest type 2 diabetes is generally not curable. Lifestyle modification is central and primarily addresses the following areas:
- Sufficient physical activity
- Healthy diet
- Reduction of increased body weight
- Stimulants: stop smoking, only a moderate consumption of alcohol (1-2 glasses per day).
These measures are also crucial for prevention. Often there are also disorders of lipid metabolism and high blood pressure, which must be treated in addition.
Drug treatment
The drug of 1st choice for drug treatment is the biguanide metformin (Glucophage, generics). Metformin inhibits the formation of glucose in the liver, reduces insulin resistance, and promotes glucose uptake into cells. The tablets are taken with meals. The most common adverse effects include digestive symptoms such as nausea, vomiting, diarrhea, abdominal pain, and taste disturbances. The dreaded lactic acidosis is extremely rare as a side effect. Metformin is often combined with other antidiabetic drugs. If metformin is insufficiently effective, if there are contraindications or if it is not tolerated, other antidiabetic drugs can also be used to lower blood sugar. They are presented under the article Antidiabetic drugs (complete list). These include (selection):
- Sulfonylureas, e.g., gliclazide (Diamicron, generics).
- Glinides: repaglinide (NovoNorm, generics), nateglinide (Starlix).
- Gliptins, e.g., sitagliptin (Januvia), vildagliptin (Galvus).
- GLP-1 receptor agonists: exenatide (Byetta, Bydureon), liraglutide (Victoza).
- Insulins, e.g., human insulin, insulin analogs.
- Glitazones: pioglitazone (Actos, generics).
- Alpha-glucosidase inhibitors: Acarbose (Glucobay)
- SGLT2 inhibitors, e.g., dapagliflozin (Forxiga).
